Surgical Risk and Pathological Results of Emergency Resection in the Treatment of Acutely Obstructing Colorectal Cancers: A Retrospective Cohort Study

Purpose@#The treatment of acutely obstructing colorectal cancers is still a matter of debate. The prevailing opinion is that an immediate resection should be performed whenever possible. This study sought to determine whether immediate resection is safe and oncologically valid. @*Methods@#We completed a retrospective 2-center cohort study using the medical records of patients admitted for acutely obstructing colorectal cancer under the care of the Colorectal Team, Noble’s Hospital, Isle of Man, and the Emergency Surgery Unit, Umberto I University Hospital, Rome, from March 2013 to May 2017. The primary endpoints were 90-day mortality and morbidity, reoperation rate, and length of stay. The secondary endpoints were status of margins, number of lymph nodes retrieved, and the rate of adequate nodal harvest. @*Results@#Sixty-three patients were retrospectively enrolled in the study. Mortality was associated with age > 80 years and Dukes B tumors. The length of hospital stay was shorter in patients who had their resection less than 24 hours from their admission, in those who had laparoscopic resection and in those with distal tumors. The number of lymph nodes retrieved and rate of R0 resections were similar to those reported in elective colorectal surgery and were greater in laparoscopic resections and in patients operated on within 24 hours, respectively. @*Conclusion@#Immediate resection is a safe and reliable option in patients with acutely obstructing colorectal cancer.

Major Pelvic Bleeding Following a Stapled Transanal Rectal Resection: Use of Laparoscopy as a Diagnostic Tool

Stapled transanal rectal resection (STARR) and stapled hemorrhoidopexy (SH) are well-established techniques for treating rectal prolapse and obstructed defecation syndrome (ODS). Occasionally, they can be associated with severe complications. We describe the case of a 59-year-old woman who underwent STARR for ODS and developed a postoperative pelvic hemorrhage. A computed tomography (CT) scan revealed a vast pelvic, retroperitoneal hematoma and free gas in the abdomen. Laparoscopy ruled out any bowel lesions, but identified a hematoma of the pelvis. Flexible sigmoidoscopy showed a small leakage of the rectal suture. The patient was treated conservatively and recovered completely. Surgeons performing STARR and SH must be aware of the risk of this rare, but severe, complication. If the patient is not progressing after a STARR or SH, a CT scan can be indicated to rule out intra-abdominal and pelvic hemorrhage. Laparoscopy is a diagnostic tool and should be associated with intraluminal exploration with flexible sigmoidoscopy.

Diagnostic accuracy of anterior drawer test in detection of anterior cruciate ligament tear using magnetic resonance imaging as gold standard

Objective: to determine the diagnostic accuracy of anterior Drawer test in detection of anterior cruciate ligament [ACL] tear, using MRI as gold standard

Study design: cross sectional study

Place and Duration of Study: department of Orthopaedics and Trauma, Khyber Teaching Hospital Peshawar, from March 2013 to September 2013

Methodology: patients presenting with post-traumatic knee pain and instability, were subjected to anterior Drawer test and then MRI of the involved knee was performed to match the findings of the two. The data was analyzed with SPSS version 10. Sensitivity, specificity, positive predictive value and negative predictive value were determined by taking MRI as gold standard

Results: a total of 115 patients were enrolled. There were 96 [83.48%] males and 19 [16.52%] females. On anterior Drawer test, true positive and true negative patients for ACL tear were 64 [55.65%] and 42 [36.52%] respectively while false positive and false negative patients for ACL tear were 3 [2.61%] and 6 [5.22%] respectively. The sensitivity and specificity of anterior Drawer test were 91.43% and 93.33% respectively while positive and negative predictive values were 95.52% and 87.50% respectively. The diagnostic accuracy was 92.20%

Conclusions: Anterior Drawer test has better specificity than sensitivity and high positive predictive value. It is more accurate in ruling out an anterior cruciate ligament injury

Reference range of zinc in adult population [20-29 years] of Lahore, Pakistan

To determine the reference range of zinc in adult population [age range 20 to 29 years] of Lahore. It was a descriptive cross sectional study which was carried out from Jan- August 2012 in Chemical Pathology Department of University of Health Sciences, Lahore. Serum zinc concentration was measured by name atomic absorption spectrometry in randomly selected 450 healthy adults aged 20 to 29 years. After application of exclusion criteria reference values were determined in apparently healthy subjects according to guidelines of International Federation of Clinical Chemistry. The data was entered and analyzed using SPSS version 20.0. Serum Zn levels was expressed as Mean +/- SD. A total of 450 healthy subjects were included in this study. Out of these, 234 were females. Mean age was 25 +/- 0.13years. The mean concentration of zinc in serum of healthy individual was 24.02 +/- 7.03 pol/L [rangel 1.47-36.72]. The mean +/- SD for males subjects were 22.33 +/- 6.42 pmol/L[range11.93-32.4]. Similarly the mean +/- SD for females were 21.72 +/- 7.34 pmol/L [range9.94-36.87]. This study presents reference range for serum zinc concentration in adult population of Lahore. The results showed that there is significant difference in serum level of zinc among different countries. This study will help us in establishing reference ranges of trace elements on larger population in future

Parathyroid hormone and magnesium levels in vitamin D deficient females

Vitamin D deficiency is a major health problem worldwide. In healthy subjects, vitamin D deficiency causes an increase in serum parathyroid hormone [PDH] level in response to hypocalcemia that in turn effectively restores serum calcium and phosphorus levels. However, the response in adult female in vitamin D deficient population in particular has not been studied especially in our set up. The objectives of this study were to determine the levels of iPTH and magnesium in vitamin D deficient adult females, among a sector of population living in a suburban area of Lahore. A total of 125 asymptomatic apparently healthy women [aged 20 - 60 years] were included in this study. Subjects were randomly selected from the Shalamar / Mughalpura area in Lahore. The research was started after taking permission from ethical committee of UHS. In a total of 125 subjects, 59 [47%] had deficient, 41 [33%] had insufficient and 25 [20%] had sufficient levels of vitamin D. The serum iPTH level in vitamin D deficient women was significantly higher and an inverse correlation existed between vitamin D and iPTH. Magnesium levels, on the other hand deteriorated only with severe deficiency of vitamin D. This study indicates that serum iPTH is a better marker of detection of low vitamin D states, as compared to serum calcium and phosphorus levels which remain normal. Furthermore, magnesium levels must be monitored in vitamin D deficiency because of its implications in bone metabolism, muscular and cardiac activity